Orthopedic Surgery

finger

(interphalangeal) synovial hinge joint

knuckle

(metacarpophalangeal) synovial condyloid joint

T/F

Be aware of heat and vapors from methyl methacrylate (bone cement)

most orthopedic surgical procedures are classified a ____________: ____________, because the incision is made under ideal surgical conditions

Class I: Clean

traumatic wounds can be classified two different ways. if the would is open and less than four hours old, it is considered _____________: _______. if the wound has been open for more than hour hours it will be considered a __________: _________

Class III: Contaminated Class IV: Dirty/infected

T/F

Examine the patient for any evidence of body infection. Even an ingrown toenail can cause a post op infection

T/F

Good patient psychological and physiological care IS important for patients having surgeries involving implants, grafts, limb reattachment or amputation

T/F

If bone does not heal back together it is called NON-UNION

T/F

MANDATORY exchange of personnel to avoid excessive fatigue

T/F

Many traumatic bone wounds involve contamination to soft tissue that is easily infected

T/F

SOME facilities use UV lights, but over-exposure is not good

T/F

a full 10 minutes mechanical and chemical scrub is required

hand table

a table attached to the bed for hand or wrist or arm surgery

tibial osteotomy

a wedge cut into the tibial plateau to correct varus or valgus deformity

scoliosis, kyphosis, and lordosis

abnormal curvature of the vertebral column that can lead to compression of internal organs and results in difficult breathing and pain

dysplasia

abnormal tissue growth and development

exostosis

abnormal, benign growth causing build up on bone surfaces. This is commonly a result of arthritis of the first metatarsal joint and causes the formation of a bunion (hullux valgus), a lateral deviation of the great toe

long arm/leg cast

above elbow/knee to wrist/ankle

osteomalacia

adult version of rickets

T/F

always insure that the extremity is ABOVE THE LEVEL of the heart to avoid swelling

single toe amputation

amputation of one toe (if spread of infection is minimal)

disarticulation

amputation of the extremity at the joint

disarticulation

amputation through a joint (stop major infection process)

describe tendon repairs and give example

an emergency procedure to re-establish a lacerated or severed tendon ex: Achilles tendon

thrombin

applied as spray or liquid solution for topical application

avitene

applied dry directly to bone surface

pneumatic tourniquet

applied for control of extremity bleeding. this is a dangerous piece of equipment

write description of elbow draping

apply impervious "down sheet" over armboard. follow with stockinette and extremity sheet

describe arthrocentesis

aspiration of synovial fluids to check for anamolies

describe bone marrow biopsy

aspiration of the marrow to check for abnormal blood count

Volkmann's contrature

atrophy of a muscle due to prolonged interference of circulation

leg holder

attached to the table to secure leg for knee surgery

ligament

band of exceptionally strong, flexible connective tissue that joins two separate bone surfaces

short arm/leg cast

below elbow/knee to wrist/ankle

osteochondroma

benign tumor in the spur of a long bone

osteoma

benign tumor of the bone

label pictures (obj. 14)

bone currettes bone cutters Hibb's chisels bone file battery powered drill gouges mallets liston amputation knife meniscus knife osteotomes rasps rongeurs bone holding clamps bone hook sweet retractor saws tendon strippers

closed (simple) fracture

bone fragments do not protrude through the skin

autogenous graft

bone from your own body

Corrective surgeries include the following:

bone graft- natural replacements for bones that can grow back implants- artificial replacements for bones that cannot be reconstructed internal and external fixation- screws, rods, pins, nails, plates, braces & casts

multiple fracture

bone is broken in several places

Corrective surgeries for orthopedic

bone reconstruction joint reconstruction tendon or ligament repair

fractured metatarsals or phalanges

broken toes

Consolidation, ____________, and bone remodeling- bone resumes its original strengths. This process continues for up to a year

calcification

describe AE (above elbow amputation)

can be short (right at shoulder=no shoulder rotation) or long (right above elbow)

myeloma

cancer of the bone marrow plasma cells

T/F

cast rooms should be separate from the OR, but if not the cast should be cut in the patients room, not in the OR

hammer toe correction

caused by narrow toed shoes

label figure 2

clavicle scapula humerus ulna radius carpals metacarpals phalanges

label picture (objective 16)

clavicle forearm wrist hip knee tibia ankle

hematoma or hemorrhage stage- blood seeps from blood vessels that have ruptured and forms a _______ at the point of injury of breakage. This is accompanied by swelling and occurs at the time of damage

clot

colles fracture

common fracture of the wrist in elderly

____________- bone splinters or breaks into more than two pieces, resulting in multiple intersecting breaks and bone fragments

communicated fracture

__________- the bones is crushed

compression fracture

intertrocanteric fracture

compression hip screw and plate

arthroscopic procedures

continuous irrigation of joint is required using 3000cc bags of NS

fluoroscope

continuous x-ray to observe implant placement

anti-inflammatory agents

cortisone steriods

body cast

covers trunk from axillae to hips for vertebrae fracture

Minerva jacket cast

covers trunk from lower head to hips

list (5) types of bone composition

cranial facial long bone flat bone short bone

_____________-done by plastic surgeons for maxiofacial or Lafort fractures

craniofacial

fragmentation fracture

crushing or shattering of bone that disperses bone throughout the injured area

osteoarthrists (OA)

degeneration due to wear and tear of the aging process

Perthes' Disease

degeneration of juvenile joints

_____________-bone is forced inward, generally to the skull

depressed fracture

special arthroscopy drape

designed with pockets containing drainage holes to reduce the risk of contamination from heavy irrigation

arthroscopy

direct visualization into a joint via an endoscope

_______________-surgeon removes the nuceus pulposus or the ruptured portion of the annulus fribrosis

discectomy

cartilage

elastic substance attached to bone surfaces where they meet

osteogenesis- bone growth can be stimulated with the use of minute ___________ impulses

electrical

electric bone stimulator

electrical current devices that stimulate bone growth

beanbags, sandbags, and pillows

elevation of an extremity or joint

frames and external fixation devices

external application of internal traction with metal pins, screws, bars, and straps

T/F

extremely delicate and lengthy procedure; often requires 12-24 hours

label figure 5

femur patella tibia fibula tarsals metatarsals phalanges

label figure 13

fibrous capsule articular disc articular hyaline cartilage fat pad fibrous capsule synovial membrane synovial fluid

joint

fibrous sheath or capsule enclosing bone surfaces where they meet

joint capsule

fibrous sheath that encloses articular bone surfaces

tendon

fibrous tissue structure that connects muscle tissue to bones and other tissue

carpal fracture

fixed with k wires

fractured olecranon

fixed with k wires and wire, or plate and screws

fractured humerus

fixed with plates and screws or a rod

describe bone densitometers

for measuring bone density

T/F

for younger arthroplasty patients no bone cement is required. metal implants have a ROUGHENED surface to allow bone to grow to implant

Buck's traction

form of skin traction with weights pulling on the extremity

complete fracture

fracture all the way through bone

incomplete fracture

fracture through part of the bone

open (compound) fracture

fragments do pierce skin

hairpin or sugartong splints

from back of hand around elbow and back to wrist

cylinder cast

from groin to ankle to immobilize knee/patella

_____________=soft granulation tissue develops and acts as an internal splint. Bone fragments are resorbed. This generally occurs within the first week after the injury

granulation

_____________-bone partially bent or broken; commonly found in children whose bones have not completely calcified

greenstick fracture

irrigation

high pressure pulsing irrigation (pulse lavage)

describe BE (below elbow amputation)

if blood supply is sufficient to the muscle and tissues below the elbow

T/F

if no complications occur, many times the prognosis of orthopedic patients is good

arthrotomy

incision into a join to biopsy the synovium

hip spica cast

includes trunk with both hips and down one/both legs

shoulder spica cast

includes trunk with shoulder and upper extremity

describe (SAP) serum alkaline phosphatase

increased levels of SAP indicate bone disease

osteomyelitis

infection that causes destruction of bone tissue

osteomyelitis

inflammation of bone tissue caused by pathogenic organisms; can lie dormant for 20-40 years

bursitis

inflammation of the synovial fluid between tendons and bones

describe arthrography

injection of dye to check cartilage and ligaments

fixative bone cement (polymehtyl methacrylate/ PNMA)

inserted into the bone to stabilize implants (EXTREME HEAT)

for more critical surgical procedures, such as a trauma patient, the patient may be transported directly to the _______________ _____ _____ because of a high risk of complications

intensive care unit (ICU)

Stages of treatment for orthopedic surgery:

investigation preservation restoration

congenital hip dislocation reduction

involves closed reduction with application of a hip spica cast

skeletal traction

involves insertion of a metal pin through the bone with weights attached

T/F

involves many specialists including orthopedic, vascular, plastic, and neurosurgeons

T/F

involves reattachment of a severed extremity; every case is DIFFERENT

femoral head fracture

involves replacement of bipolar hip implants

osteoporosis

lack of calcium in bone, resulting in fragile bones that are easily broken

_______________-removal of the lamina in the individual vertebra to gain access to the spinal cord

laminectomy

hip dislocation

lateral and upward dislocation of the femoral head in infants less than 2 years old

braces or cast

made of cloth or foam

Andrew's frame

maintain patient in modified knee-chest position

___-_____ = bone heals but is not in proper alignment

mal-union

chondrosarcoma

malignant tumor of hyaline cartilage

osteosarcoma

malignant tumor of the bone

repair of joint dislocation

manipulating the associated bones back into proper alignment

describe the method of (CREF) Closed reduction via external fixation

manipulation of fracture of bone using external devices such as casts or traction

describe the method of (OREF) open reduction with external fixation

manipulation of the fracture via an incision. Fixation, once the procedure is completed, used external devices such as cast or traction

cortical graft

matchsticks or small narrow slices of bone

describe (ESR) erythrocyte sedimentation rate

measures rate red blood cells fall

synovial

membrane that lines the joint capsule

gelfoam

moistened with saline, thrombin or epinephrine in pad form, then applied over areas of capillary bleeding

polydactylism

more than the usual number of fingers or toes

tuberculosis of bone or joint

most common in spine

braces

most often metal devices that provide rigid support to minor fractures or weak joints or postoperatively

fracture table

narrow flat table that supports only the trunk and provides traction to reduce fractures

splints

non-encasing devices that can be wrapped in plaster or bandages to immobilize a fracture

_________= fracture shows no evidence of healing

non-union

____________ fracture line lies at an angle to the long axis of the bone

oblique

an ________ fracture viewed as a medical emergency because of the risk of infection

open

bone

osseous tissue that comprises individual parts of the skeleton

dupuytren's contracture release

partial or total excision of the palmar fascia

T/F

pass sharps on a magnetic mat where available

bristow procedure

performed for recurrent dislocation of the shoulder

articular cartilage shaving

performed on aging and wearing of cartilage

transverse fracture line lies ____________________ to the long axis of the bone

perpendicular

write description of knee draping

place impervious down sheet under affected leg covering opposite leg. apply stockinette over foot and leg to tourniquet then place extremity sheet or split sheet

articulation

point of contact or connection between bones

write description of shoulder skin prep

prep entire arm and shoulder. requires a second person to hold arm or an arm holder

Acromioplasty

procedure to relieve impingement of the soft tissue in the joint

glenohumeral dislocation repair

procedure to tighten the ligaments connecting the glenoid fossa to the humeral head

ossification

process of bone development and fusion, ending at about 25 years of age

isolation drape

provides separation of sterile supplies, staff and equipment from non-sterile area of anesthesia, ESU, suction, and radiographic equipment

label figure 12

radioulnar joint hip joint symphysis pubis joint knee synovial joint metatarsophalangeal joint shoulder joint elbow joint wrist joint finger joint sacroiliac joint ankle joint

describe ligament repairs and give example

reconstruction of ligaments may require non-absorbable sutures, wires, staples, and grafts ex: trigger finger release

Types of fracture treatment include all of the following:

reduction rehabilitation immobilization

most orthopedic surgical procedures are performed under general or ____________ anesthesia which require the patient to be transported to the PACU until the patient is awake

regional

syndactyly release

release of webbing between digits

ganglion cyst excision

removal of a fluid filled sac in the wrist

Baker's cyst excision

removal of a soft tissue cyst from the posterior popliteal fossa

synocectomy

removal of excessive synovium

bunionectomy

removal of exotosis of the MPJ

wrist arthroplasty

removal of injured or arthritic carpals

medical or lateral meniscectomy

removal of meniscus

The primary purposes of orthopedic surgery includes?

repair revision reconstruction reattachment removal of: -bones, joints and affected tissues -tendons, ligaments or cartilage

fractured ankle joint

repair of medial and lateral malleolus with plate and or screw

rotator cuff repair

repair of torn rotator cuff muscles

strain

repetitive stretching of joint, tendon or ligament

arthroplasty of the humeral head

replace humeral head with implants

total hip arthroplasty

replacement of the acetabular cup and femoral head with implants

total ankle arthroplasty

replacement of the ankle joint

arthroplasty of the total elbow

replacement of the distal portion of the humerus and the proximal portion of the ulna with implants

fractured femoral shaft

requires closed reduction and the use of a femoral rod

T/F

requires extensive, detailed positioning of patient and affected areas

internal fixation devices

rods, plates, screws, nails and wires

herniation

rupture in the fibrous cartilage, most often discs and vertebrae

_____________- Luc or Harrington rods are attached to the vertebral processes

scoliosis

press-fit implants

secured without the use of cyanoacrylate or bone cement

Boney callus formation- this process begins 3-4 weeks after injury and continues for several months. ________ ___ ___ _______

shows up on x-ray

____________-where bones remain in proper relation to each other and the skin remains intact. little tissue damage

simple (closed)

T/F

some facilities use a cooling apparatus which provides a continuous flow of cooling fluid around the joint (NOT AIR)

T/F

some patient's bodies may reject the implant if they are on medication for their immune system

T/F

sometimes SPECIAL AIR CLEANING SYSTEMS are used

__________ _________-stabilizes the vertebrae using bone graft

spinal fusion

_________ fracture line forms a spiral pattern around the bone

spiral

cancellous graft

spongy bone scooped out with gouge

arthrodesis

stabilization of the joint. usually degenerative

fractured tibia

stabilize the tibia with a rod or plates and screws

bone wax

sterile beeswax applied directly to cut bone surfaces. assists hemostasis in bone

T/F

strict adherence to aseptic technique must be followed and prophylactic antibiotic given because a simple superficial infection can continue deeper into the bone, which can result in any implants having to be removed

write description of hand position

supine with armboard

write description of hip positioning

supine with sandbag placed under thigh or lateral with bean bag and pillows for extremity support

write description of ankle or foot skin prep

support affected leg using a leg holder or by supporting the leg at the knee. Betadine scrub and paint cicumferentially from knee to and including the feet and toes

T/F

surgeons CANNOT estimate with certainty what the outcome will be for each individual orthopedic patient

arthroplasty

surgical repair of a joint by reshaping or replacing joint

intercarpal

synovial plane joint

carpometacarpal

synovial saddle joint (to thumb) or synovial plane joint (to other digits)

Rheumatoid arthritis (RA)

systemic deterioration of connective tissue, especially the joints

arthroplasty of the tarsals

tarsals replaced with implants

ulner nerve transposition

the anterior ulnar nerve is brought to the posterior position after elbow trauma

T/F

the basic sequence for a reattachment procedure is: BONE VASCULATURE AND NERVES RESTRUCTURING

cancellous bone

the spongy bone found at the ends of long bones and within flat bone; contains red marrow

arthrodesis

the surgical fixation of a joint

T/F

there are some additional scrub attire for orthopedic surgery, but it MAY NOT BE USED FOR ALL ORTHO CASES

Another primary purpose of orthopedic surgery includes:

to investigate, preserve and restore form & function to the musculoskeletal structures, associated tissues of the extremities and also the spine

AC separation repair

to repair or reattach the ligaments at the joint between the acromion and the clavicle

dislocated joint

torn joint support structures such as ligaments or tendons

knee arthroplasty implants

total knee or hinged knee

MPJ arthroplasty

total replacement of the MPJ joint with prosthesis

total knee arthroplasty

total replacement of the knee joint

sutures

tough and resilient

fractures of the radius and ulna

treated with k wires or plate and screws, or rush rod

excision of radial head

treatment for osteoarthritis of the elbow

fibroma

tumor of connective tissue

repair of ACL, PCL

use of autogenous or homogenous grafts

vicryl sutures

used for work with periosteum

ethibond, prolene, and nurolon sutures

used in attaching tendon to bone

surgical steel sutures

used most often in bone-to-bone closures, but is occasionally used to secure tendons

adjustable extremity appliances

used to hold an extremity in position

traction devices

used to provide a steady, constant pull with alignment of the distal portion of the fracture site

arm holder

used to raise arm during shoulder procedures

wooden or metal splints

used to support digits or other joints

abduction splint

usually applied right after hip surgery to maintain constant abduction

fractured fibula

usually reduced without the need for implants

wilson frame

utilized for prone position

perineal post

utilized to provide resistance to the traction

arthroscopic support equipment

video system, monitor, cameras

describe arthroscopy

visual inspection of joint

rickets

vitamin D and calcium deficiency that leads to abnormal bone growth in children

syndactylism

webbing between adjacent digits